Neuroprotective Benefit of Renin-Angiotensin System Blocking Agents in Carotid Artery Surgery

Renin-angiotensin system blocking (RASB) agents such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are considered first-line antihypertensive agents. However, their role in the perioperative period of carotid artery interventions is unclear. We examined relationship between use RASB for patients undergoing endarterectomy (CEA), transfemoral stenting (CAS), transcervical revascularization (TCAR). The Vascular Quality Initiative database was queried all who had undergone CEA, TCAR, CAS. baseline procedural characteristics postoperative outcomes were compared agent users nonusers. primary outcome neurologic events (stroke transient ischemic attack). secondary included mortality, cardiac events, complications. Multivariate logistic regression used to determine independent predictors events. More than 150,000 analyzed, including13,666 13,811 CAS, 125,429 CEA (Fig). On univariate analysis, associated with lower after (1.7% vs 2.0%; P = .001). No difference detected TCAR (2.0% 2.4%; .162) CAS (3.4% 3.2%; .234) cohorts. mortality (1.2% 1.7%; did not influence overall rates including myocardial infarction, dysrhythmia, congestive heart failure intervention types or groups. multivariable independently significantly (odds ratio [OR], 0.819; 95% confidence interval [CI], 0.747-0.898; .01) (OR, 0.869; CI, 0.768-0.984; .026), but 0.967; 0.884-1.057; .461; Table). decreased those Because warrant absolute minimization complications be efficacious, neuroprotective effect during warrants further examination.TableMultivariable analysis resultsOR95% CI1.1471.083-1.2151.0621.030-1.0951.0301.009-1.0521.0260.978-1.0761.0191.003-1.0340.9990.964-1.0360.8950.790-1.0150.8880.782-1.0080.8190.747-0.8980.7690.698-38471.2301.020-1.4831.0551.003-1.1081.0471.002-1.0940.9620.844-1.0961.2080.914-1.5950.9890.911-1.0731.1540.752-1.7731.0260.813-1.2950.8690.768-0.9840.8630.812-0.916CI, Confidence interval; OR, odds ratio.Boldface values represent statistical significance. Open table a new tab